Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Introduction: More than half a million children worldwide die from the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) each year. In Uganda, HIV/AIDS is a major cause of infant and childhood mortality. Although the government of Uganda, through various strategies, has increased access to antiretroviral drugs (ARVs), resulting in national scaling up of accessibility to antiretroviral therapy (ART), initiation of ART in resource-limited areas remains a challenge due to constraints such as the absence of or limited number of CD4 machines and related laboratory constraints. Further scaling up of ART for children would be greatly strengthened by increased access to laboratory services for CD4 counts or the introduction of alternative indicators or guidelines for the initiation of ART. Aim: This study therefore set out to investigate, through the analysis of retrospectively collected data, whether anthropometric indices (wasting - weight for height; underweight - weight for age; and stunting - height for age) could provide a useful alternative guide when deciding about initiation of ART in children aged 2-12 years in the absence of sophisticated clinical and laboratory support. Methods: The study was conducted at the Mildmay Centre, an HIV/AIDS specialist centre located in Kampala, Uganda. Parameters such as the age at which children had been initiated onto ART, duration on ART, World Health Organisation (WHO) and Centre for Disease Control (CDC) disease stages at time of initiation, anthropometry at time of initiation, CD4% staging at time of initiation, support received from food aid programmes, referral to other health centres as a result of malnutrition and care-giver nutrition education/counselling were all determined retrospectively from clinical records. Results: It was found, based on CDC (2000) growth reference charts, that of the total number of children who took part in this study (N=125), 98.4% were mildly wasted, 52.8% mildly underweight and 75.2% mildly stunted when they were initiated onto ART. Of the children, who had WHO disease staging documented - 40% (N=50), the majority - 86% (N=43) were in WHO disease staging II and III during initiation of ART. and 96% (N=48) were mildly wasted. However, the relationship between WHO disease staging and wasting, underweight, and stunting at initiation of ART in children at the Mildmay centre was not significant. The relationship between CD4% and underweight or stunted children was also not significant. It was established however, that in the absence of CD4 laboratory parameters (since CD4% is vital in the initiation of ART in children) as is the case in resource limited areas, anthropometric indices (moderate to severe wasting, weight for height -W/H) could be used concurrently with CDC and WHO disease staging to initiate ART in children. However, it is important to note that anthropometric indices on their own cannot be used as a guide for initiating ART in children. Conclusion: Anthropometric status alone cannot be used to accurately determine when to initiate ART in children 2-12 years.

Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / Obesity is recognizably a chronic disease worldwide and childhood obesity has considerable implications for long‐term health. Manipulation of modifiable lifestyle variables, such as high‐fat energy‐dense diets and decreased physical activity are often recommended for positive (although not always significant) outcomes. This study aimed to determine the specific relationships between ready‐to‐eat cereals (RTEC) consumption (regular RTEC breakfast consumption and regular RTEC afternoon snack consumption), regular increased physical activity, and anthropometric measures [body weight, percentage body fat, and body mass index (BMI)] amongst young adolescents attending public Gauteng schools. A randomised controlled trial was conducted over 5‐weeks amongst 212 cross‐cultural, male and female, English speaking children aged 10‐13 years attending two selected public Gauteng schools. Participants were randomly allocated to one of four cohorts (Control, Step, RTEC or Step & RTEC). The control cohort had no prescribed intervention, the Step cohort had prescribed stepping intervention only (completion of 2 000 additional steps in a 20‐minute period on 3 school days per week), the RTEC cohort had prescribed RTEC consumption intervention only (consumption of a single RTEC serving at breakfast and RTEC snack serving as an afternoon snack on each school day), and the Step & RTEC cohort had both the prescribed stepping and RTEC consumption interventions. Participants were assessed anthropometrically at baseline and at the end of the 5 weeks. They also submitted a food/activity diary from which quantitative measures of their intake and activity were determined. The Step (107 845 ± 31 251) and Step & RTEC (108 793 ± 26 285) cohorts both completed significantly more mean total steps than Control (83 501 ± 22 302) and RTEC (86 082 ± 23 367) cohorts (p≤0.01), and a significant negative correlation (p=0.02; r=‐0.21) was found between the change in percentage body fat and the total steps completed. The Step & RTEC (14.32 ± 7.95) and RTEC (16.06 ± 8.82) cohorts consumed more RTEC snack servings as afternoon snacks than Control (1.13 ± 1.69) and Step (1.59 ± 2.50) cohorts (p≤0.01), and a significant negative correlation (p=0.03; r=‐0.20) was found between the participants’ change in weight and the servings of RTEC snacks consumed as an afternoon snack. No significant difference (p=0.35) was achieved in mean weight change across the four cohorts, although both Step & RTEC (‐0.12 ± 0.81) and RTEC (‐0.24 ± 0.77) cohorts showed a mean decrease in body weight. No significant difference (p=0.47) was achieved in mean change in percentage body fat across the four cohorts either, although all cohorts showed a decrease in percentage body fat, with Step cohort (‐0.32 ± 0.70) showing the greatest mean change. The stepping intervention alone brought about greatest decrease in percentage body fat, while the RTEC consumption intervention alone brought about greatest decrease in body weight and BMI. The combination of interventions was the least effective of the three interventions in bringing about decreases in percentage body fat.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of the study was to determine the prevalence of certain known risk factors for intra-uterine growth restriction (IUGR) in women who gave premature birth to growth-restricted infants at a large regional hospital (Kalafong) in the Gauteng province of South Africa and to investigate the possible associations between the presence of various risk factors and the severity of growth restriction found in these infants. METHOD: The study was designed as cross-sectional, descriptive and observational. The subjects included singleton growth-restricted premature infants (n=80), without congenital abnormalities and their mothers (n=80). Anthropometric data [weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSF)] were collected from these mothers three to four days post-partum. Infant birth weights were recorded at birth, while the lengths and head circumferences were recorded within 2 days post-partum. Additional information, such as birth spacing, maternal age, smoking habits and alcohol use, was collected by personal interview and blood pressure data and HIV status was obtained from medical records. Data capturing and descriptive statistics were done using Microsoft Excel and comparative analytical statistics were performed with the Statistical Package for the Social Sciences (SPSS), version 12.0. RESULTS: The study demonstrated a high prevalence (69%) of infants born with a birth weight <3rd percentile. In the sample, 81% of the mothers were aged 17-34 years and most (93%) had their children 18 months or longer apart. Malnutrition prevalence was moderate. In 58% of the mothers the BMI was normal (18.5-24.9 kg/m2) and in 47% the upper arm muscle area (UAMA) was between the 10th-85th percentile. Grade III overweight occurred in 3% and TSF ≤5th percentile occurred in 35% of the mothers. About half (51%) of the mothers in the sample population had hypertension during the second trimester of pregnancy. Smoking and alcohol use during pregnancy was rare (1% and 6% respectively) and the prevalence of HIV infection in the mothers was 26%. The prevalence (16%) of Grade II overweight among the mothers of symmetric growth-restricted (SGR) infants was higher than among the mothers of asymmetric growth-restricted (AGR) infants (7%). Of the hypertensive mothers, 55% had infants with SGR compared to 45% with AGR (p=0.47). Although rare, smoking occurred only in mothers with AGR infants (3%). No significant differences were found between the smoking and non-smoking group (p=0.21). Although the use of alcohol was more prevalent at 6% in mothers with SGA infants and 7% in mothers with AGR infants, no significant associations were found (p=0.95). Although not significant (p=0.76), there was a higher prevalence of HIV infection in mothers with SGR infants at 29%, compared to 23% of mothers of AGR infants. CONCLUSION: Although further studies are needed before intervention strategies can be planned and implemented, the findings of this study suggest that apart from the usual factors (maternal age and nutritional status, smoking and alcohol use during pregnancy and birth spacing) that may influence intra-uterine growth, hypertension may contribute greatly to IUGR in this study population.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2008. / BACKGROUND: Although hypoglycaemia is a known complication of haemodialysis, there is little information about its prevalence among patients on maintenance haemodialysis. OBJECTIVE: To determine the prevalence of hypoglycaemia in patients on maintenance haemodialysis in Kenyatta National Hospital (Nairobi, Kenya) and to identify potential nutritionrelated causes of hypoglycaemia. METHODS: A cross-sectional, descriptive and observational study design was followed. Patients who had been on chronic maintenance haemodialysis for 3 months or longer were included in the study which was carried out from May 8 through to June 30, 2006. Random blood glucose levels were determined at baseline, 15 minutes, 30 minutes and 45 minutes, and at hourly intervals thereafter until the end of the dialysis session. The prevalence of hypoglycaemia (a blood glucose level less than 3.9 mmol/L) was then determined for the duration of haemodialysis. The relationship between minimum blood glucose levels and dietary intake, anthropometric status, primary diagnosis, co-morbid and socio-demographic factors, prescribed medication and dialysis related factors was determined. RESULTS: Among the 51 haemodialysis patients who participated in the study, the prevalence of hypoglycaemia was 16% (n=8). Eight percent (n=4) of these patients were however already hypoglycaemic on initiation of dialysis. Dietary intake of niacin ((r=0.31; p=0.02), riboflavin (r=0.30; p=0.03) and vitamin B6 (r=0.30; p=0.03) showed a significant relationship with blood glucose levels. The relationships between hypoglycaemic episodes and insulin administration (p=0.06), and between blood glucose levels and BMI (r=0.25; p=0.08 and protein intake (r=0.26; p=0.07) approached significance. There was no significant relationship between blood glucose levels and the duration of haemodialysis (p=0.942), hours of haemodialysis (p=0.27) and the dialysate solution used (p=0.12). CONCLUSIONS: Hypoglycaemia was present in 16% of patients on maintenance haemodialysis. Potential nutritional parameters which may have contributed to lower blood glucose levels in this study include a lower dietary intake of niacin, riboflavin, and vitamin B6. Lower protein intake and lower BMI was marginally associated with low blood glucose levels.

Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / Background Critical illness is associated with increased production of reactive oxygen species and oxidative stress, and low levels of most micronutrients with resultant diminished endogenous antioxidant defences. Micronutrient supplementation is thought to be beneficial to the critically ill patient by ameliorating oxidative stress and by improving clinical outcome. Objectives This systematic review assessed the effects of micronutrient supplementation on adults recovering from critical illness. Primary outcomes included clinical endpoints [mortality, infectious complications, length of intensive care unit and hospital stay (LICU and LOS)]. Secondary outcomes included descriptions of practice issues, micronutrient status, morbidity, course of the acute phase response and oxidative stress. Search strategy An electronic bibliographic database search was carried out, bibliographies of retrieved articles were reviewed and personal files searched to obtain additional citations. Databases were searched from inception until 29 February 2008. Selection criteria Randomized controlled trials (RCTs) of micronutrient supplementation (by any route) in adult critically ill patients, given in addition to their routine care, were included. Data collection and analysis Two authors independently extracted data and assessed trial quality. For the primary outcomes the random-effects model was used to estimate overall relative risk / mean difference and effect size due to the presence of study heterogeneity. Selected exploratory analyses were undertaken. Differences at the level of p<0.05 was considered to be statistically significant. The secondary outcomes were sparse and variably recorded such that this data was not formally aggregated. Main results Fifteen RCTs involving 1714 participants and 18 RCTs involving 1849 participants were included for the primary and secondary objectives respectively. The quality of the RCTs, as reported, was disappointing, particularly for allocation concealment. Fourteen trials (n=1468) of micronutrient supplementation showed a statistically significant reduction in overall mortality [relative risk (RR) 0.78, 95% confidence interval (CI) 0.67-0.90, I2=0%, p=0.0009]. An asymmetrical funnel plot necessitates caution when directly interpreting these results. Six RCTs (n=1194) indicated a statistically significant reduction in 28 day mortality (RR 0.75, 95% CI 0.63-0.88, I2=0%, p=0.0006) (symmetrical funnel plot). Micronutrient supplementation in this systematic review was not associated with a reduction in infectious complications, LICU or LOS. In sub-group analyses, single nutrients were associated with borderline statistical significance (RR 0.82, 95% CI 0.66-1.01, I2=0%, p=0.06) in terms of mortality, whist a sensitivity analysis of combined micronutrients indicated a significant reduction in mortality (RR 0.69, 95% CI 0.54-0.90, I2=2%, p= 0.006). This review did not find clear evidence that parenteral is superior to enteral administration in terms of clinical outcomes. The secondary outcomes confirmed that timing, duration and dosing are key factors to ensure optimal clinical benefit. Conclusion This review does suggest potential benefit of micronutrient supplementation in critically ill adults for some clinical outcomes (especially mortality), but also highlights that caution is warranted as nutrient interactions and risk of toxicity are not clearly defined in critical illness. More large multi-centre randomized trials are necessary to assess the effects of different types and doses of micronutrient supplementation in selected groups of patients with different types of critical illness.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Background This study aimed to define the prevalence of side-effects and the change in weight and BMI during radical radiotherapy for head and neck malignancies (HNM) at Tygerberg Academic Hospital (TBH), Western Cape, South Africa. Acute side-effects may delay or prevent the delivery of a complete curative radiotherapy dose. Weight loss has been shown to significantly worsen prognosis and increase prevalence of treatment complications. However, weight maintenance may lead to beneficial outcomes. Assessing the impact of radical radiotherapy on patients with HNM is therefore critical and can promote development and implementation of medical and nutritional interventions. Methods Patients were weighed before and weekly during radiotherapy. Blood was drawn before, during and at the end of radiotherapy so that the Prognostic Inflammatory and Nutritional Index (PINI) could be calculated. Selected clinical data, clinical grades of mucositis and the diagnosis of a fungal infection of the oral cavity were extracted from clinical records. The McMaster Head and Neck Radiotherapy Questionnaire and a Lifestyle and Dietary Questionnaire were administered weekly. Descriptive statistics and the following were used: ANOVA, Repeated Measures ANOVA and McNemar Chi-square tests. Results Thirty-eight patients were recruited and 21 completed the study. Follow-up occurred over a maximum of nine weeks. A decrease in the weight (p = 0.01) and BMI (p = 0.01) and increase in the PINI (p = 0.04) occurred during radiotherapy. The mean absolute weight loss was 3.2kg (4.8), the mean percentage weight loss was 4.5% (6.7) and the mean decrease in BMI was 1.2kg/m2 (1.8). There was an increase in the prevalence of malnutrition (p = 0.02), as defined in this study. Oral mucositis occurred in all participants from Week 4; the majority developing Grade II or III Mucositis. Fungal infection of the oral cavity was prevalent throughout radiotherapy, with the highest prevalence (30%) in Week 4. Increases in severity of symptoms related to the mouth (p = 0.0000), throat (p = 0.05) and skin domains (p = 0.0000) occurred. Fifty-nine percent of inpatients and 45% of outpatients were prescribed supplementation drinks and most participants reported that a dietitian had not consulted them, in each week of radiotherapy. Discussion Severe side-effects in the mouth, throat and skin were experienced and a decline in nutritional status was observed. The poor nutritional status prior to commencing and weight loss during radiotherapy could have increased the severity of side-effects. The induction of the acute phase response indicated that this could have contributed to the decline in nutritional status observed. In addition, the infrequent nutritional support is likely to have further contributed to the lack of weight maintenance. Conclusion This first study conducted in South Africa has demonstrated the prevalence of significant side-effects and change in weight and BMI in this patient population. It is recommended that more effective analgesic medication is prescribed and that measures are taken to improve oral hygiene of participants to prevent fungal infection of the oral cavity. Improved nutritional support in terms of regular dietetic follow-up of all patients and more frequent prescription of supplementation drinks during radiotherapy is also recommended.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction and Objectives: Schools can serve as a supportive environment for the promotion of healthy eating in order to prevent childhood overweight and obesity and the development of noncommunicable diseases such as cardiovascular diseases, type 2 diabetes mellitus, fatty liver disease, muscoskeletal disorders and some cancers. Tuck shops at schools often offer unhealthy items that are energy dense and high in fat and/or sugar with a low content of vitamins, minerals and dietary fibre. The availability of unhealthy items in tuck shops prevents learners from making healthy food choices, since children tend to choose unhealthy foods when given a choice. In addition to unhealthy items offered by tuck shops, learners also bring unhealthy items to school in their lunchboxes. The aim of the study was to investigate the influence of a nutritionally-regulated tuck shop on primary school learners’ perceptions, attitudes and behaviour towards healthy eating in a Bloemfontein, Afrikaans medium, co-education primary school, and compare it to learners of a school with a conventional tuck shop. Methods: In a cross-sectional survey with an analytical component, grade 2 to 7 learners in a school with a nutritionally-regulated tuck shop (n=116) and a school with a conventional tuck shop (n=141) completed a questionnaire. Six learners per grade also took part in focus group discussions. Questions related to lunchbox contents and perceptions, attitudes and behaviour towards the tuck shop and healthy eating. Nutritional information of the items available for purchase at each of the school tuck shops was collected. Results: The lunchboxes of learners in the school with a nutritionally-regulated tuck shop contained significantly (p<0.05) more healthy items (fruit, water and muffins), as well as significantly more unhealthy items (sweets and chips). The items offered by the nutritionally-regulated tuck shop contained approximately half the kilojoules compared to items offered by the conventional tuck shop. Learners in the school with a nutritionally-regulated tuck shop liked certain fruits and vegetables significantly (p<0.05) more than learners in the school with a conventional tuck shop. Statistical significant differences (p<0.05) between different grades and gender showed that grade 2 learners in both schools had a less positive attitude towards certain fruit and vegetables compared to the older learners, while girls in both schools were more positive towards certain fruits and vegetables compared to boys. Younger learners had a more positive attitude towards their nutritionally-regulated tuck shop than older learners. In both schools learners had similar perceptions regarding the particular school’s tuck shop and healthy eating. Conclusion: The hypothesis that learners in a school with a nutritionally-regulated tuck shop have positive attitudes, perceptions and behaviour towards healthy eating was rejected. The availability of healthier items in a school tuck shop had a positive influence on certain behaviours and attitudes of learners, but the potential value of controlling the type of items available for purchase at schools might be counteracted by lunchbox contents, certain fixed eating patterns, perceptions of learners and previous exposure to a conventional tuck shop. Recommendations include a multi-pronged approach such as the Health Promoting Schools concept. / AFRIKAANSE OPSOMMING: Inleiding en doelwitte: Skole bied ‘n omgewing waar goeie eetgewoontes bevorder kan word ten einde oorgewig en vetsug in kinders te voorkom, asook die ontwikkeling van nie-oordraagbare siektes soos kardiovaskulêre siektes, tipe-2 diabetes mellitus, lewervervetting sindroom, ortopediese komplikasies en sekere soorte kanker. Snoepies in skole voorsien meestal ongesonde items met ‘n hoë energie, vet- en/of suikerinhoud en wat laag is in vitamiene, minerale en dieetvesel. Die beskikbaarheid van ongesonde items in snoepies verhoed dat leerders gesonde voelselkeuses uitoefen, omdat kinders geneig is om voorkeur aan ongesonde kos te gee as hulle 'n keuse gebied word. Benewens die ongesonde items wat snoepies aanbied, neem leerders boonop ongesonde kos in hul kosblikke skooltoe. Die doel van die studie was om by 'n Afrikaans dubbelmedium laerskool in Bloemfontein die invloed van ‘n voedingkundig-gereguleerde snoepie op leerders se persepsies, houdings en gedrag teenoor gesonde eetgewoontes te ondersoek en te vergelyk met leerders in 'n skool met 'n konvensionele snoepie. Metodes: In ‘n deursnit-opname met ‘n analitiese komponent, het graad 2 tot 7 leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie (n=116) en ‘n skool met ‘n konvensionele snoepie (n=141), ‘n vraelys ingevul. Ses leerders in elke graad in elk van die skole het ook aan fokusgroepbesprekings deelgeneem. Vrae het oor die inhoud van kosblikke, asook persepsies, houding en gedrag teenoor die snoepie en gesonde eetgewoontes, gehandel. Voedingsinligting rakende die items wat in elk van die skole se snoepies verkoop word, is ook ingesamel. Resultate: Die kosblikke van leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie het statisties beduidend (p<0.05) meer gesonde items bevat (vrugte, water en muffins), maar ook beduidend meer ongesonde items (lekkergoed en aartappelskyfies). Voedsel-items wat in die voedingkundig-gereguleerde snoepie beskikbaar was, het omtrent die helfte minder energie bevat as voedsel-items wat in die konvensionele snoepie beskikbaar was. Leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie het beduidend (p<0.05) meer van sekere groente en vrugte gehou as leerders in ‘n skool met ‘n konvensionele snoepie. Statisties beduidende (p<0.05) verskille tussen verskillende grade en die houding van verskillende geslagte dui daarop dat graad 2 leerders in albei skole minder positief gevoel het oor sekere groente en vrugte as ouer leerders, terwyl meisies in albei skole ‘n meer positiewe houding teenoor sekere groente en vrugte getoon het as seuns. Jonger leerders het ‘n meer positiewe houding teenoor hulle voedingkundig-gereguleerde snoepie getoon as ouer leerders. In albei skole het leerders soortgelyke persepsies rondom hul onderskeie skole se snoepies en gesonde eetgewoontes openbaar. Gevolgtrekking: Die hipotese dat leerders in ‘n skool met ‘n voedingkundig-gereguleerde snoepie positiewe persepsies, houding en gedrag teenoor gesonde eetgewoontes toon is nie aanvaar nie. Die beskikbaarheid van gesonder items in ‘n skoolsnoepie het 'n positiewe invloed op sekere eetgewoontes en houdings van die leerders, maar die potensiële waarde daarvan om die tipes voedsel wat by skole te koop aangebied word te reguleer mag egter teengewerk word deur kosblikke se inhoud asook sekere vaste eetpatrone, persepsies van leerders en vorige blootstelling aan ‘n konvensionele snoepie. ‘n Veelvoudige benadering soos die konsep van ‘n Gesondheidbevorderingskool word aanbeveel.

Thesis (MNutrition )ITE))--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: The primary objective was to determine whether pregnant women visiting primary health care clinics (PHCs) were aware of the nutritional supplementation programmes: Nutrition Supplementation Programme (NSP) food, folate-, iron- and vitamin A supplementation. The secondary objective was to determine whether pregnant women qualified for the NSP food-, folate- and iron supplementation. The third objective was to determine whether those who qualified received the prescribed NSP food-, folate-, and iron supplementation and whether they were compliant with these interventions. Design: A cross-sectional descriptive study was conducted at all PHCs hosting basic antenatal clinics in the Cape Town Metropolitan Area of the Western Cape Province, South Africa. Method: One hundred and fourteen pregnant women who met the inclusion criteria were included in the study using a non-random quota sampling strategy. Pregnant women were interviewed using a validated questionnaire. The mid upper arm circumference (MUAC) was measured and the symphysis-fundus (SF) measurement was obtained from the medical files to determine whether participants met the entry criteria for the NSP. Written informed consent was obtained from participants. Results: Fifty per cent of participants were between 12 and 24 weeks of gestation. Most of them (68%) had an MUAC of between 24,7 cm and 34,4 cm. Fifty (44%) of the participants had a sufficient SF measurement. Twenty-one (18%) of the participants indicated that they were aware of the vitamin A Programme, 56 (49%) were aware of the NSP food-supplementation and 79 (70%) knew about the folicand iron supplementation that pregnant women should receive from the clinic. Six (5%) participants qualified for the NSP with an MUAC of below 23 cm. Only one (17%) participant was registered with the NSP and received the food-supplementation. Seventy (61%) of the participants indicated that they received and used the iron- and folic supplements, of which 30 (43%) did not know why they needed to take these supplements. Conclusion: Folate- and iron supplementation appears to be reasonably successfully implemented in the Cape Town Metropolitan Area among pregnant women visiting PHCs. The NSP food-supplementation, however, appears to be unsuccessfully implemented and needs further attention. Resources could be appointed to inform pregnant women about the reasons for and importance of taking these supplements. / AFRIKAANSE OPSOMMING: Inleiding: Die hoofdoelstelling was om te bepaal of swanger vroue wat primêre gesondheidsorgklinieke (PGK’s) bywoon, bewus was van die voeding supplementasie programme: Voedsel Supplementasie Program (VSP) – voedselaanvulling, folaat-, yster- en vitamien A supplementasie. Die tweede doelstelling was om te bepaal of hierdie swanger vroue in aanmerking kom vir die VSP– voedselaanvulling, folaat- en yster supplementasie. Die derde doelstelling was om te bepaal of hierdie swanger vroue die voorgeskrewe VSP – voedselaanvulling, folaat- en yster supplementasie ontvang het en hierdie intervensies nagevolg het. Ontwerp: ʼn Deursnit beskrywende studie is gedoen en data is ingesamel van al die PGK’s wat voorgeboortelike klinieke huisves in die Kaapstadse metropolitaanse gebied, in die Wes-Kaapprovinsie, Suid-Afrika. Metode: Honderd en veertien swanger vroue wat aan die insluitingskriteria voldoen het, is volgens ʼn nie-ewekansige kwotastrategie uitgesoek om aan die studie deel te neem. Onderhoude is volgens ʼn bevestigde vraelys met swanger vroue gevoer. Die omtrek van die middelboarm is geneem en die symphysis-fundus-meting is van die mediese lêers verkry om te bepaal of deelnemers aan die insluitingskriteria vir die VSP voldoen. Deelnemers het ʼn vrywaringsvorm geteken voordat hulle aan die studie begin deelneem het. Resultate: Vyftig persent van die swanger vroue het ʼn gestasie-ouderdom van tussen 12 en 24 weke gehad. Die omtrek van die meeste vroue (68%) se middelboarm was tussen 24,7 cm en 34,4 cm. Vyftig (44%) van die vroue se symphysis-fundusmeting was voldoende. Een en twintig (18%) van die deelnemers het aangedui dat hulle van die Vitamien A-program bewus was, 56 (49%) was van die VSPvoedselaanvulling bewus en 79 (70%) van die deelnemers was bewus van die folaat- en yster supplementasie wat swanger vroue van die kliniek behoort te ontvang. Ses (5%) deelnemers, met ʼn middelboarm-omtrek van minder as 23 cm, het vir die VSP in aanmerking gekom. Slegs een (17%) deelnemer was geregistreer en het die voedselaanvulling ontvang. Sewentig (61%) van die deelnemers het aangedui dat hul wel yster- en folaat supplementasie ontvang en gebruik, waarvan 30 (43%) nie geweet het waarom hulle dié supplemente neem nie. Gevolgtrekking: Dit wil voorkom asof folaat- en yster supplementasie vir swanger vroue wat PGK’s in die Kaapstadse metropolitaanse gebied besoek, redelik suksesvol toegepas word. Daarteenoor word die VSP – voedselaanvulling onsuksesvol uitgevoer en behoort dit verdere aandag te geniet. Hulpbronne kan aangewys word om swanger vroue beter in te lig oor die doel en belangrikheid daarvan om hierdie supplemente te neem.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: Considering the myriad of risk factors causing nutritional deficiency, as well as the prevalence of malnutrition and feeding problems experienced by individuals with intellectual disability (ID), early detection and diagnosis of malnutrition in this population group is essential. Objectives: The main aim and objectives of the study were to determine the degree of malnutrition and body composition in individuals with ID living in a psychiatric hospital (North West Province, South Africa), to determine which degree of ID was more prone to malnutrition, to investigate the different risk factors for malnutrition in this group of individuals, and to use this data to adapt an existing screening tool used to facilitate the easier identification of malnutrition. Methodology: An observational descriptive cross-sectional study, with an analytical component, was conducted. The study consisted of two phases. During the first phase, measurements were taken of individuals with ID to determine body composition and nutritional status. During the second phase, said data, as well as other factors influencing the nutritional status of individuals with ID, were used to adapt an existing screening tool to allow for easier identification of malnutrition in the study population. The adapted screening tool was tested by nursing staff. Results: The anthropometric measurements of 244 individuals with ID were determined. The overall anthropometrical status indicated that half of the study population (52,1%, n=127) had a normal nutritional status, that 38,1% (n=93) was undernourished or at risk of becoming undernourished, and that 10,0% (n=24) was either at risk of becoming or was overnourished . Men were more prone to being undernourished or at risk of becoming undernourished (48,0%, n=73), compared to women (21,7%, n=20). Although no significant difference was found in anthropometrical status across the four severities of ID (Pearson Chi-square test (ρ=0,15)), individuals with mild ID were more likely to become obese (19,4%, n=6), and individuals with profound ID were more prone to being underweight (57,1%, n=8). It was found that 41,8% (n=102) of the total study population had a waist circumference (WC) above the normal values. A significant difference was found between increased WC and severity of ID (Pearson Chi-square test (ρ=0,00)). Other risk factors that can influence nutritional status in said population included medical conditions such as hypertension (13,0%, n=32) and epilepsy (EP) (46,0%, n=112), as well as polypharmacy (71,7%, n=175). An existing malnutrition screening tool for the population with ID was adapted by means of the addition of prevalent factors (WC measurements, presence of EP and use of medications), as well as through adaptation of the scoring system. Conclusion: Using anthropometric measurements and indices for body composition, a high prevalence of malnutrition was identified in the study population of individuals with ID. The adapted screening tool was more sensitive than the original tool in identifying individuals who were at risk of malnutrition, or who were already malnourished in this study population. The research undertaken in this respect can help health care professionals to be more aware of the interaction between the severity of ID and malnutrition. / AFRIKAANSE OPSOMMING: Agtergrond: Wanneer daar gelet word op die magdom faktore wat voedingstekorte veroorsaak en op die voorkoms van wanvoeding en voedingsprobleme onder individue met intellektuele gestremdheid (IG), is dit duidelik dat vroegtydige waarneming en diagnose van wanvoeding noodsaaklik is. Doelwitte: Die hoofdoel en doelwitte van die studie was om die graad van wanvoeding sowel as die liggaamsamestelling van individue met IG te bepaal wat in ’n psigiatriese hospitaal (Noordwes Provinsie, Suid-Afrika) inwoon. Daar is bepaal watter graad van IG individue is meer geneig tot wanvoeding. Verskillende risiko faktore van wanvoeding in hierdie groep individue is ondersoek en die data is gebruik om ’n bestaande siftingshulpmiddel aan te pas om wanvoeding makliker te kan identifiseer. Metodologie: Die studie-ontwerp was ‘n dwarssnitwaarnemingstudie met ‘n analitiese komponent. Die studie het uit twee fases bestaan. Gedurende die eerste fase is antropometriese metings van individue met IG geneem om liggaamsamestelling en voedingstatus te bereken. Gedurende die tweede fase is hierdie data, sowel as ander risiko faktore wat die voedingstatus van individue beïnvloed, gebruik om ’n bestaande siftingshulpmiddel aan te pas wat die identifisering van wanvoeding in hierdie populasie kan vergemaklik. Verpleegpersoneel het die aangepaste siftingshulpmiddel uitgetoets. Resultate: Die antropometriese metings van 244 individue met IG is bepaal. Hulle algemene antropometriese status het aangedui dat die helfte van die studiepopulasie (52,1%, n=127) ’n normale voedingstatus gehad het; 38,1% (n=93) was ondervoed of het ’n risiko gehad vir ondervoeding en 10,0% (n=24) was reeds oorvoed of het ’n risiko gehad vir oorvoeding. Mans (48,0%, n=73) was meer geneig om ondervoed te wees of het ‘n groter risiko tot ondervoeding as vroue (21,7%, n=20). Daar was geen beduidende statistiese verskille in antropometriese status tussen die vier grade van IG nie (Pearson Chi-square-toets, p=0,15), alhoewel individue met matige IG ‘n groter neiging het tot obesiteit (19,35%, n=6), terwyl uitgesproke IG ’n groter neiging tot ondergewig gehad het (57,1%, n=8). Daar is bevind dat 41,8% (n=102) van die totale studiepopulasie ’n verhoogde middelomtrek gehad het. Daar was ʼn beduidende statistiese verskil tussen verhoogde middelomtrek en graad van IG (Pearson Chi-square-toets, p=0,00). Ander risiko faktore wat die voedingstatus van hierdie populasie kan beïnvloed sluit in mediese toestande soos hipertensie (13,0%, n=32) en epilepsie (46,0%, n=112), asook die gebruik van veelvuldige medikasie (71,7%, n=175). ’n Bestaande wanvoedingsiftingshulpmiddel vir die IG populasie is aangepas deur algemene faktore (middelomtrek, voorkoms van epilepsie en gebruik van veelvuldige medikasie) in te sluit en die puntestelsel aan te pas. Gevolgtrekking: Met behulp van antropometriese metings en liggaamsmassa indekse is ’n hoë voorkoms van wanvoeding in die studiepopulasie van individue met IG waargeneem. Die aangepaste siftingshulpmiddel was meer sensitief as die oorspronklike hulpmiddel om individue wat ’n risiko loop vir wanvoeding of wat reeds wangevoed is, te identifiseer in hierdie studie populasie. Hierdie navorsing kan help om gesondheidswerkers meer bewus te maak van die interaksie tussen die graad van IG en wanvoeding.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The role of fructose restriction in addition to dietary modifications for weight loss and lifestyle improvement, on fertility outcome and other markers of metabolic syndrome, in obese women with polycystic ovarian syndrome (PCOS) Introduction: At the time at which the current study was undertaken no data, as yet, existed on whether restriction of fructose, while treating obese patients with PCOS for weight loss, improves the clinical symptoms and metabolic/anthropometric profile so as to promote fertility. Objectives: To evaluate the baseline intake of fructose, as well as the effect of restricting fructose intake from fruit and soft beverages to less than 20 g daily, as well as to provide guidelines for weight loss on anthropometric measurements, for improving subjective clinical symptoms, and for promoting fertility outcome in obese patients with PCOS, who seek to become fertile. Methods: The study was conducted in the Tygerberg Hospital Infertility Clinic, as an experimental cohort. Patients with a body mass index (BMI) higher than 27, seeking fertility after diagnosis with PCOS, were referred for dietary consultation, and followed up 3 monthly over 1 year. At each visit anthropometric measurements and a detailed dietary history were taken and a questionnaire for clinical symptoms was completed. Results: Baselinely, 86 patients were included in the study. Averages for weight and BMI were 99.8 ± 24.3 kg and 39.2 ± 8.7kg/m2, respectively. Average baseline daily fructose intake was 167 ± 116.8g. At baseline, significant relationships were shown between fructose intake and burning feet (ρ=0.02) and frequent waking (ρ=0.02), with a trend towards nightly eating (ρ=0.07). The dropout rate after visit 1 was 50%, with a further dropout of 41% after visit 2. After 3 visits (n=18), fructose intake significantly reduced (ρ=0.018), with the significant relationships with clinical symptoms having disappeared by visit 2. After 3 visits (n=18), both weight and BMI decreased significantly (ρ=0.017) and (ρ=0.019), respectively. Fructose was tested as a covariate to BMI, with high significance (ρ=0.006) in said population group. Conclusion: Dietary intervention to reduce fructose intake proved significant for weight loss and BMI after 3 visits. Reduced fructose intake was associated with reduced clinical symptoms. With fructose being a significant covariate to BMI, it can be concluded that fructose overconsumption could possibly contribute to both clinical symptoms and elevated BMI in said study population. / AFRIKAANSE OPSOMMING: Die rol wat die beperking van fruktose speel bykomend tot dieetaanpassings en lewenstylverbetering vir gewigsverlies by oorgewig vroue met polisistiese ovariële sindroom (PCOS) in die uitkoms van fertiliteit en ander merkers van metaboliese sindroom. Inleiding: Met die aanvang van hierdie studie was daar is geen data beskikbaar oor die invloed van die beperking van fruktose in die dieet van oorgewig pasiënte met PCOS wat vir gewigsverlies behandel word nie. Dit was ook nie bekend of laasgenoemde pasiënte se kliniese simptome en metaboliese/antropometriese profiel sou verbeter met die beperking van fruktose sodat fertiliteit by hierdie pasiënte terselfdertyd ook bevorder word nie. Doelwitte: Die evaluering van die aanvanklike inname van fruktose, sowel as die beperking van fruktose afkomstig van eetbare vrugte en versoete drankies en sap tot ’n inname van minder as 20 g daagliks, tesame met riglyne vir gewigsverlies. Die uitkoms hiervan is bepaal deur antropometriese metings, die verbetering in subjektiewe kliniese simptome en die fertiliteituitkoms by oorgewig pasiënte wat hulp met fertiliteit verlang. Metodes: Die studie het as ’n eksperimentele kohort by die Infertiliteitskliniek by Tygerberg Hospitaal plaasgevind. Pasiënte wat na diagnose met PCOS fertiliteitsbehandeling verlang het en ’n BMI hoër as 27 gehad het , is vir dieetbehandeling verwys en driemaandeliks oor ’n tydperk van een jaar opgevolg. Tydens elke besoek is antropometriese metings en ’n omvattende dieetgeskiedenis geneem en ’n vraelys oor kliniese simptome ingevul. Resultate: Aanvanklik is 86 pasiënte by die studie ingesluit. Gemiddeldes vir gewig en BMI was 99.8 ± 24.3 kg en 39.2 ± 8.7 kg/m2 respektiewelik. Gemiddelde aanvanklike daaglikse inname van fruktose was 167 ± 116.8 g. Oorspronklik het betekenisvolle verhoudings tussen fruktose en die volgende bestaan: brandvoete (ρ=0.02) en veelvuldige episodes van nagtelike wakkerheid (ρ=0.02), met ’n neiging na nagtelike etery (ρ=0.07). Die uitvalsyfer na een besoek was 50% met ’n verdere uitvalsyfer van 41% na die tweede besoek. Na drie besoeke (n=18) het sowel die gewig as die BMI betekenisvolle afname getoon (ρ= 0.017) en (ρ=0.019), respektiewelik. Fruktose is as ’n belangrike kovariant vir BMI (ρ= 0.006) vir hierdie populasiegroep geïdentifiseer. Gevolgtrekking: Dieetintervensie vir die vermindering van die inname van fruktose was beduidend vir gewigsverlies en afname in BMI na drie besoeke. Verminderde fruktose-inname het gelei tot die vermindering van kliniese simptome. Met fruktose as beduidende kovariant vir BMI kan die gevolgtrekking gemaak word dat die oor-inname van fruktose by hierdie studiepopulasie waarskynlik tot sowel kliniese simptome as BMI bygedra het.